MEDICARE: DEKALB MEMORIAL HOSPITAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CC4531	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508937376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB MEMORIAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 623
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-0623
Country	:	US
Telephone Number	:	260-357-6557
Fax Number	:	260-357-0373

Provider Business Practice Location Address
First Line	:	128 N RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1138
Country	:	US
Telephone Number	:	260-357-6557
Fax Number	:	260-357-0373

Authorized Official
Title or Position	:	BILLING COLLECTION MANAGER
Name	:	MS. PENNY LYNN GRIFFIN
Credential	:	CPC
Telephone Number	:	260-920-2794

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/12/2012

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Directions to “DEKALB MEMORIAL HOSPITAL, INC ” Practice Location

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